Pregnancy has its Risks. More Women Will Face Them Without Roe.

Somehow the physical reality of pregnancy has been ignored in the debate over abortion and the beginning of human existence. It's not simply a little inconvenience. Pregnancy puts a load on the body, which can have life-altering or even life-threatening consequences. It literally weighs down the heart. If the US Supreme Court overturns Roe v. Wade case, permitting states to prohibit or severely restrict abortion, the number of pregnancies carried to term will increase, as will the number of persons exposed to pregnancy's health concerns.

From the initial pumping of heart cells to viability, the abortion debate revolves around foetal development. What happened to the woman is as follows: Her blood volume begins to rise at four weeks of pregnancy, increasing by 50% by the time she gives birth. To pump that more blood, the heart beats quicker, with the majority of it going to the uterus, placenta, and kidneys. The kidneys grow in volume, size, and filtration.

The body's way of protecting against bleeding, which has long been a primary cause of childbirth-related death, blood clotting grows stronger, peaking just before delivery. Pregnant women, compared to non-pregnant women of reproductive age, have a five-fold increased risk of deep vein thrombosis, a painful and sometimes life-threatening clot that generally occurs in the legs. They are three times as likely to have a stroke, with Black women having an even higher risk.

In 2020, 861 women will have died as a result of pregnancy-related causes, the most prevalent of which are cardiovascular events. Approximately 60,000 women experienced major childbirth-related problems, which do not include severe prenatal or postpartum disorders. Approximately 7% of women acquire gestational diabetes, and a similar percentage develop gestational hypertension, both of which can cause acute and long-term health issues.

Karen Florio was well aware of all of these factors when she became pregnant at the age of 33. She has helped many women negotiate difficult medical conditions as a maternal-fetal medicine doctor in Kansas City, Missouri, who specialises in cardio-obstetrics. She has advised individuals on the option of terminating a pregnancy owing to life-threatening issues on a few occasions. She had no idea, however, that she would soon be lying in a hospital bed, facing her own life-or-death situation. 

Florio had always been the epitome of health. She finished an Ironman triathlon before becoming pregnant. She was a softball player in college. She has no prior medical issues. Her blood pressure then rose to 147/97 at 28 weeks of pregnancy. (A blood pressure of 120/80 or less is considered normal.) She'd observed that her face was swollen and that her weight gain, despite her strict diet, seemed excessive. These were symptoms of preeclampsia, or persistently high blood pressure during pregnancy or after delivery, which affects 5% to 8% of all newborns. I think I missed all the signals because it never occurred to me that I could get preeclampsia, she says, despite though it's [a condition] I'm constantly aware of.

Florio began to have headaches and specks in her eyesight as her blood pressure increased to 160/100. Mother and child ended up in separate ICUs after her baby was delivered by C-section at 31 weeks. Preeclampsia caused posterior reversible encephalopathy syndrome, or PRES, which is characterised by brain swelling.

Florio made a full recovery. She is back to her triathlete routines today, and her eight-year-old son is OK. But her heart still races now and then, something it hadn't done previously and which could be a sign of future cardiac problems. The heart never truly returns to normal, she explains. Because of the increasing hazards, she opted against having another child.

Her state, Missouri, has triggered legislation that prohibits all abortions "save in circumstances of a medical emergency" if Roe is overturned. It would be the physician's or health provider's legal responsibility to demonstrate that a person is in danger. Twelve other states have trigger laws that would prohibit or restrict abortion, and five have pre-Roe bans that would take effect if Roe were to be reversed. Some "no exception" laws force women to sustain pregnancies after rape or incest, and some "no exception" bans prevent women from terminating pregnancies even if they miscarry.

Delayed care could generate a new form of pregnancy risk in states with severe anti-abortion laws. According to a study conducted by academics at Washington University in St. Louis, states with the most stringent abortion regulations had higher rates of maternal mortality from 2009 to 2017. The study didn't set out to find a cause, but the authors hypothesised a few possibilities: States with fewer restrictions may have greater resources to assist women's health. People with high-risk pregnancies who are unable to abort them may be more likely to die from complications in more restricted states.

Medical professionals have been warning about an increase in cardiovascular issues even before the draught US Supreme Court judgement that might overturn Roe became available. Because the physical strain of pregnancy might disclose heart-related issues with long-term consequences, it is often referred to as "nature's stress test." In 2021, a Lancet panel on women and cardiovascular disease identified a number of under-appreciated dangers, including peripartum cardiomyopathy, a type of heart failure that develops late in pregnancy or after delivery. "Heart disease is the No. 1 killer of new parents," according to the American Heart Association's "Go Red for Women" campaign.

Strokes can strike quickly and without warning. After delivery, some people's blood pressure rises, posing a silent threat at a time when women are less inclined to follow up on their medical treatment. (And they may have lost insurance; despite government incentives, 12 states have failed to expand Medicaid to cover the postpartum year.)

Stroke isn't common—it affects roughly 45 per 100,000 pregnant or postpartum women—but it's also not uncommon. Approximately half of the instances result in long-term disability. "It may be terrible," says Louise D. McCullough, chief of neurology at Memorial Hermann Hospital in Houston and a stroke expert. These are young women, says the narrator. It has a big impact on the family whether they become incapacitated or die.

For McCullough, one recent case stands out: After an unremarkable first pregnancy, a 26-year-old lady got a severe headache a few weeks after giving birth. She suffered a major brain haemorrhage from a clot, known as cerebral vein thrombosis, by the time she arrived at the hospital. Her life was saved temporarily by clot-busting medication, but she died of complications a few months later. Monitoring blood pressure, even postpartum, and intervening quickly when a problem emerges, according to McCullough, can make a life-changing difference. "It's critical to understand that pregnancy can be a risky time for women," she says.

Why does pregnancy so frequently result in major health problems? The nuMoM2b trial is tracking roughly 4,500 moms for years after their pregnancies to gain some insight into cardiovascular repercussions. The study, which was carried out at eight medical institutions across the United States and was supported by the National Institutes of Health, looked at the link between "adverse pregnancy outcomes," such as gestational hypertension or preterm birth, and the mother's future cardiovascular health. (This is analogous to the well-known Framingham Heart Study, which has been going on since 1948 and has led to new insights into cardiovascular risks.) Higher triglycerides, high-sensitivity C-reactive protein, and blood glucose levels were linked to hypertension two to seven years after delivery, according to research.

To better understand the risks of maternal death, Eugene Declercq, a maternal health researcher at Boston University School of Public Health, has been tracking severe maternal morbidity—serious complications of pregnancy. It's a major issue: Half of all pregnancy-associated deaths occur within a year after birth, when they may not even be recognised as being related to the pregnancy. And, according to Declercq, medical incidents that occur outside of the hospital require additional attention. "At the hospital, the rate of maternal mortality has decreased," he says. "The ongoing rise is being driven by community deaths, both prenatal and postpartum."

It's difficult to say how many more people would die after Roe if they were forced to carry their pregnancies to term because they couldn't get an abortion, but a sociologist at the University of Colorado, Boulder, estimates that maternal deaths will rise by 21%—and by 33% for Black women, who are the most vulnerable. Unplanned pregnancies, on average, result in poorer results for moms and newborns, owing to delays in prenatal treatment. Even with present abortion limitations in place in the United States, about 40% of births are unexpected or undesired, a figure that will undoubtedly climb if states are allowed to prohibit abortions.

"I'd want to see those states who are so eager to impose limitations say, 'And by the way, we're going to significantly strengthen care for pregnant women,'" Declercq says. He is pessimistic. Seven of the 12 states that haven't expanded Medicaid coverage to more low-income adults have trigger laws or past abortion prohibitions that will take effect immediately if Roe is overturned. State legislators in other states have promised to impose a ban or tighter limits. Boosting women's health, pregnant or not, isn't part of their post-Roe strategy.